HFEL Office of Program Compliance State Enforcement (12/20/2013)

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1 HFEL Office of Compliance State (12/20/2013) Secretary Survey Deficiency reported on a State Survey Send Action Alert or fax to Team and Secretary Send Packet by interoffice mail to OPC 1 Prepare Packet and prepare OPC Action Tracking Record 2 Enter event into State Steno Book and assign the next control number Enter info into OPC database 3 Place packet in the state basket for Copy signed enforcement Enter enforcement info into OPC database 4 Send to OPC enforcement list with enforcement info Mail original to facility State Action enforcem ent Specialist Retrieve packet and identify deficienty with highest scope and severity Prepare enforcement per enforcement grid Draft from appropriate template Incorporate edits and print final draft for signature Send to Director/ Manager for signature Director or Manager Review enforcement Edits needed? Return to program specialist to incorporate edits Sign enforcement and send to secretary 1. Acute sends a paper packet. Long term care will either fax, send the survey as an attachment, or notify that a survey with deficiencies was entered into ASPE 2. If IJ, may printout for ease of use. If less complex, may solely on ASPE. 3. Survey information, deficiencies, date, control number 4. Enter penalties and remedies and the date into the OPC database

2 HFEL Office of Compliance State (12/20/2013) Manager Mark physical calendar with facility payment due date Call facility reminding them of payment Installment plan needed? Create hardcopy record 2 Record payment into OPC db Facility Receive state enforcement with civic Pay in-full within 30 days? Pay installments Admin 1 Enforcem ent Receive check Log check receipt and make a copy Inform Manager of received payment Transfer check to admin 2 Admin 2 Deposit check Hardcopy file includes enforcement, copy of the check, amount paid, check #. Filed by facility and can also include information about installment payments

3 HFEL Office of Compliance Federal (12/13/2013) Secretary Survey Deficiency reported on a Federal Survey Inform Team and Secretary 1 Receive Package and prepare OPC Action Tracking Record 2 Enter event into Federal Steno Book and assign the next control number Enter info into OPC database Place package in the fed basket for Draft using the appropriate template Submit to program specialist for Print final and submit for Director s signature Copy and mail to facility Specialist Retrieve package and ascertain scope and severity Prepare enforcement within the allotted time 3 Record in ASPE, enforcement section Return to secretary to draft the Review and edit Does it require directors? Send to director for Return edited to secretary for final printing Director/ Manager Review and edit enforcement Sign enforcement 1. Survey may inform enforcement by fax or . When fax, OPC tracking form is often sent. When , OPC tracking form may be attached, or it may inform enforcement that an OPC tracking form is available in ASPE. 2. Preparation of the OPC Tracking Record involves writing the date received on the OPC TRACKIG FORM; entering the control number, facility name, and admins onto the VARIABLE SHEET; Reviewing and pulling the facility history from the OPC and ASPE databases. 3. Federal standards for turnaround: 2 days for immediate jeopardy, 10 days for potential harm, 120 days for medium. according to the grid, however CMS is developing a new CMP formula.

4 HFEL Office of Compliance Informal Dispute Resolution (12/13/2013) OPC Provider 1.0 Requests Informal Dispute Resolution 1.01 Log IDR request in ASPE associated with deficiency tag 1.1 Request a conference? 1.11 Schedule a Conference with Provider, Survey, and IDR Panel 1.12 Schedule IDR Panel with Provider 1.2 Submit 10 packets of supporting materials at least 10 days prior to IDR 2.0 Hold IDR Conference for max of 1 hr 2.1 Discuss and decide if a change to the survey is warranted 2.21 Submit requested info to IDR Panel 2.2 Request more info from Provider? 2.3 Request more Info from Survey? 3.0 Render a decision 3.1 Recommend a change?* Communicate change decision to Survey 3.2 Contact provider by phone and send a decision 3.3 Send Survey decision by 3.4 Close out in ASPE Survey 2.31 Submit requested info to IDR Panel 3.11 Generate a new survey report* Send copy of updated survey to the facility *For a nursing home challenge, the Panels decision is a to CMS. CMS has final authority to accept or reject the changes. ew items: 1.01 Requests for IDR are logged into the IDR tab in ASPE. They may be entered by OPC or Survey Communicate change to survey: May be in person if it s an in-person IDR, or may be by phone communicate new survey to the facility does this happen?

5 HFEL Office of Compliance Independent Informal Dispute Resolution (12/13/2013) ursing Home CMS Office 1.0 Offers Independent Informal Dispute Resolution 1.1 Accept IIDR? 1.11 Facility pays CMP as required 1.2 Accept within 30 days with 5 copies of all written documents of supporting evidence 1.3 Submit to J OPC 4.2 Receive changed OPC 2.0 Compile written record and notify involved resident and J OOIE 2.1 Request comments from resident and J OOIE 2.2 Submit copies of all docs and comments (if any) to DOH LTC* 4.1 otify facility of the change in 4.0 Agree with rec? 4.01 Submit file to CMS for final decision 3.0 Schedule and conduct IIDR 3.1 Rule on the IIDR 3.2 Change J ruling? 3.3 Write an explanation for the change and send to J with supporting docs DOH 3.21 Communicate no change with facility and close IIDR Offered to nursing homes for deficiencies of scope and severity constituting actual harm, substandard quality of care, or immediate jeopardy to resident health or safety, that lead to the imposition of a civil monetary penalty (CMP) and for which notices has been provided by CMS to the nursing home that the CMP will be collected and place in escrow. *ew ork State Department of Health Office of Long Term Care, Bureau of Quality Assurance and Surveillance OOIE J Ombudsman for. 1.1 Requests are sent electronically through (HICS) 2.1 OOIE responds to requests for more information with word documents 2.2 packet is send to DOH as one large PDF file 3.3 sent as an via HICS